US20070191852A1

Movatterモバイル変換

Info

Publication number: US20070191852A1
Application number: US11/340,884
Authority: US
Inventors: Daniel Shimko; Jeetendra Bharadwaj; Carlos Gil; Eric Weeks
Original assignee: SDGI Holdings Inc
Current assignee: Warsaw Orthopedic Inc
Priority date: 2006-01-27
Filing date: 2006-01-27
Publication date: 2007-08-16
Also published as: US8317792B2; US20100198223A1; US7722614B2

Abstract

A surgical procedure and a device used in the procedure according to which one end portion of a guide rod is inserted into the condyle of a damaged area of a human. The rod is used as a guide for a drill bit and a chisel to cut an opening in the condyle.

Description

BACKGROUND

This invention relates to an improved osteochondral implant fixation method and, more particularly, to such a method in which a recipient opening is prepared for receiving a graft.

In the human body, the knee consists of three articulating components—a femur, a tibia, and a patella—that are held in place by various ligaments. The corresponding chondral areas of the femur and the tibia form a hinge joint, and the patella protects the joint. Portions of the latter areas, as well as the underside of the patella, are covered with an articular cartilage, which allow the femur and the tibia to smoothly glide against each other without causing damage.

The articular cartilage often tears, usually due to traumatic injury (often seen in athletics) and degenerative processes (seen in older patients). This tearing does not heal well due to the lack of nerves, blood vessels and lymphatic systems; and the resultant knee pain, swelling and limited motion of the bone(s) must be addressed.

Damaged adult cartilages have historically been treated by a variety of surgical interventions including lavage, arthroscopic debridement, and repair stimulation, all of which provide less than optimum results.

Another known treatment involves removal and replacement of the damaged cartilage with a prosthetic device. However, the known artificial prostheses have largely been unsuccessful since they are deficient in the elastic, and therefore in the shock-absorbing, properties characteristic of the cartilage. Moreover, the known artificial devices have not proven able to withstand the forces inherent to routine knee joint function.

In an attempt to overcome the problems associated with the above techniques, osteochondral transplantation, also known as “mosaicplasty” or“OATS” has been used to repair articular cartilages. This procedure involves removing injured tissue from the articular defect and drilling cylindrical openings in the base of the defect and underlying bone. Cylindrical plugs, consisting of healthy cartilage overlying bone, are obtained from another area of the patient, typically from a lower weight-bearing region of the joint under repair, or from a donor patient, and are implanted in the openings. However, in these cases, if the opening is too large, the graft can rotate in the opening and become loose, which will prevent integration with the surrounding tissues. If the opening is too small, significant cellular damage can occur to the graft during the implantation.

Co-pending U.S. patent application Ser. No. 11/120,136, filed Apr. 30, 2005, addresses the above problems with cylindrical grafts by disclosing a implanting technique involving grafts including at least one bone portion having a cross-sectional profile other than that of a circle and including a mechanical stop to resist rotation. The disclosure of this application is hereby incorporated by reference.

An embodiment of the present invention involves a technique for providing an opening in the defect having dimensions corresponding to those of the grafts disclosed in the above application.

BRIEF DESCRIPTION OF THE DRAWING

FIG. 1 is an elevational view of a human knee with certain parts removed in the interest of clarity.

FIG. 2 is an isometric view of a tripod used in a procedure according to an embodiment of the invention.

FIG. 3 is an isometric view of a guide rod used in the procedure.

FIG. 4 is an isometric view of a drill bit used in the procedure.

FIG. 5 is an isometric view of a chisel used in the procedure.

FIG. 6A depicts the tripod ofFIG. 2 extending over a portion of the femur ofFIG. 1.

FIG. 7 depicts the femur ofFIG. 1 with the opening made in accordance with the procedure.

DETAILED DESCRIPTION

Referring toFIG. 1 of the drawing, thereference numeral10 refers, in general, to a knee area of a human including afemur12 and atibia14 whose respective chondral areas are in close proximity. Acartilage16 extends over a portion of the chondral area of thefemur12, and ameniscus18 extends between the cartilage and thetibia14. The patella, as well as the tendons, ligaments, and quadriceps that also form part of the knee are not shown in the interest of clarity.

It will be assumed that a portion of thecartilage16 extending over achondral area12aof thefemur12 has been damaged and removed by the surgeon, or has worn away, and it is desired to create an opening in the damaged area, or defect, to receive a graft. It will also be assumed that a graft having a square cross section is harvested or prepared from another area of the patient/recipient, or from any number of anatomic sites, animal or otherwise, in accordance with the disclosure of the above patent application.

Referring toFIG. 2, atripod20 is provided that consists of an elongatedtubular body member22 having three

legs

22a,22b, and22c, each extending downwardly from one end of the body member and at an angle to its axis. The legs20a,20b, and20ccan be formed integrally with thebody member22 or can be fabricated separately and attached to the body member in any conventional manner. Abore22dextends through the entire length of thebody member22.

Aguide rod24 is shown inFIG. 3 and is in the form of an elongated solid cylinder having a threadedend portion24a.

Referring toFIG. 4, adrill bit26 is provided that consists of abody member28 having acontinuous bore28a. Ahelical cutting thread28bis formed on the outer surface of one end portion of thebody member28, and the other end portion has a reduced-diametersolid portion28chaving a hexagonal cross section for receiving a chuck (not shown).

A cutting device, or chisel,30 is shown inFIG. 5 and includes abody member32 having acontinuous bore32a. Ahollow cutting blade34, having a rectangular cross section, is provided at one end of the body member, and ahandle36 is provided on the other end. Indicia are formed on the outer surface of theblade34 for reasons to be described.

According to the procedure, and with reference toFIG. 6A, the portion of the damaged area, or defect,12athat is to receive the graft is marked using a sterile pen, and thetripod20 is placed over the mark, with thelegs22a-22cengaging the corresponding surfaces of thefemur12 around the mark. A guide mark is made on theguide rod24 a predetermined distance from the end of its threaded end portion, with the distance from the mark to the latter end corresponding to the desired depth of the guide rod insertion.

As shown inFIG. 6B, theend portion24aof theguide rod24 is then inserted into and through thebore22din thetripod20 until it engages the mark on thedefect12a. The other end portion of theguide rod24 projects outwardly from the corresponding end of thetripod20 which receives a chuck (not shown) of a hand or electric drill. Torque is applied to therod24 to drive its threadedend portion24ainto the condyle of thefemur12 until the marked portion of the rod extents flush with the chondral area of thedefect12a. Thetripod10 is then removed, leaving theguide rod24 implanted in the condyle and extending perpendicularly to the chondral area.

Referring toFIG. 6C, thedrill bit26 is advanced over the rod until the end of thecutting thread28bengages the chondral area of thedefect12a. A mark is made on thecutting thread28bof thedrill bit26 that extends a distance from the corresponding end of the drill bit corresponding to the desired depth of the opening to be formed in thedefect12a. In the event that some of the damagedcartilage16 remains, then the end of thecutting thread28bwould initially be rested on its upper surface. Theother end portion28cof thebody member28 is engaged by a chuck (not shown) of a hand or electric drill. Then the drill is activated at a relatively low RPM with very little manual pressure until the cutting thread26bfully penetrates any of thecartilage16 remaining on the chondral area of thedefect12a. The pressure on thebit26 is then increased so that the cuttingthread28bstarts cutting the subchondral condyle. This continues until the marked portion of the cuttingthread28bextends flush with the chondral area of thedefect12a. Thus, an opening having a circular cross-section is formed in thedefect12aand extends to the desired, predetermined depth.

Thebit26 is removed from therod24 and thechisel30 is advanced over the rod until the end of thecutting blade34 engages the chondral area of thedefect12a. Then, manual force is applied to thechisel30 so that the blade expands the opening cut by thebit26 into anopening12bhaving a rectangular cross section corresponding to the cross-section of the blade.

It is understood that a dilator, or the like (not shown) can be inserted in theopening12bto smooth out the walls of the opening as necessary and expand the opening a relatively small amount as necessary to permit insertion of the graft. A dialator of this type is shown in co-pending application No. (Attorneys' docket P-22591 and 31132.432), filed Jan. 26, 2006, the disclosure of which is hereby incorporated by reference.

Theopening12bis shown inFIG. 7, extends perpendicularly to the chondral area, and is adapted to receive a graft (not shown) of a corresponding size.

It is understood that, during the above procedure, any of themeniscus18 or related tendons, ligaments and quadriceps are removed or pushed aside as necessary to permit access to thedefect12ato permit the forming of theopening12b.

Variations

1. The shape and dimensions of theopening12bcan vary within the scope of the invention. For example, the opening can be circular or have just one planar surface.

2. Theguide rod24 can be hammered into the condyle using a light hammer.

3. The spatial references mentioned above, such as“upper”,“lower”,“under”, “over”,“between”,“outer”,“inner” and“surrounding” are for the purpose of illustration only and do not limit the specific orientation or location of the components described above.

4. The present invention is not limited to knees of humans but rather is applicable other damaged areas of all animals.

5. Thegraft20 can be harvested or prepared from another area of the patient/recipient, or from any number of anatomic sites, animal or otherwise

6. The method and device disclosed above can be used in any surgical or experimental situation (animal species or otherwise) to create prepared recipient sites in any anatomic region containing cartilage or bone.

7. The opening formed in accordance with the above can accept a cartilage or bone substitute material.

8. Theopening12bcan be adapted using appropriately shaped reamers, curettes, press-fit expanders or dilators, or other general surgical instruments.

9. Should the defect be sufficiently large to not be completely resurfaced using one graft, this procedure can be repeated with one or more additional openings and grafts adjacent to theopening12b.

10. The tripod in the above embodiment can be replaced by similar manual/visual instruments to achieve similar perpendicularity.

Those skilled in the art will readily appreciate that many other variations and modifications of the embodiment described above without materially departing from the novel teachings and advantages of this invention. Accordingly, all such variations and modifications are intended to be included within the scope of this invention as defined in the following claims. In the claims, means-plus-function clauses are intended to cover the structures described herein as performing the recited function and not only structural equivalents, but also equivalent structures.

Claims

1. A surgical procedure comprising:

inserting one end portion of a guide rod into a damaged area of an animal, the remaining portion of the rod projecting out from the damaged area,

advancing a hollow drill bit over the rod until the drill bit extends to the damaged area;

activating the drill bit to drill an opening having a circular cross section in the area;

removing the drill bit from the rod;

advancing a hollow cutting blade having a rectangular cross section over the rod until the blade extends to the opening; and

exerting force on the cutting blade to form at least one planar surface in the damaged area that defines the opening.

2. The procedure ofclaim 1 further comprising placing a tripod over the damaged area before the first step of inserting, and extending the guide rod through the tripod.

3. The procedure ofclaim 2 wherein the axis of the tripod, and therefore the rod, extends perpendicularly to the surface of the damaged area.

4. The procedure ofclaim 1 further comprising removing the rod from the opening.

5. The procedure ofclaim 1 wherein the cutting blade is formed at one end of a body portion of a chisel.

6. The procedure ofclaim 1 wherein the damaged area is a bone, or a bone with an overlying cartilage.

7. A surgical procedure comprising:

inserting one end portion of a guide rod into the damaged area of a human, the remaining portion of the rod projecting out from the damaged area,

advancing a hollow cutting blade having a rectangular cross section over the rod until the blade extends to the opening;

exerting force on the cutting blade to form at least one planar surface in the damaged area that defines the opening; and

removing the rod from the opening.

8. The procedure ofclaim 7 further comprising:

activating the drill bit to drill an opening having a circular cross section in the area; and

removing the drill bit from the rod.

9. The procedure ofclaim 7 further comprising placing a tripod over the damaged area before the first step of inserting, and extending the guide rod through the tripod.

10. The procedure ofclaim 9 wherein the axis of the tripod, and therefore the rod, extends perpendicularly to the surface of the damaged area.

11. The procedure ofclaim 7 wherein the cutting blade is formed at one end of a body portion of a chisel.

12. The procedure ofclaim 7 wherein the damaged area is a bone, or a bone with an overlying cartilage.

13. A surgical procedure comprising:

inserting one end portion of a guide rod into the condyle of a damaged area of a human, the remaining portion of the rod projecting out from the condyle,

activating the drill bit to drill an opening in the area;

removing the drill bit from the rod; and

removing the rod from the opening.

14. The procedure ofclaim 13 further comprising:

15. The procedure ofclaim 14 wherein the cutting blade is formed at one end of a body portion of a chisel.

16. The procedure ofclaim 13 further comprising placing a tripod over the damaged area before the first step of inserting, and extending the guide rod through the tripod.

17. The procedure ofclaim 16 wherein the axis of the tripod, and therefore the rod, extends perpendicularly to the surface of the damaged area.

18. The procedure ofclaim 13 wherein the damaged area is a bone, or a bone with an overlying cartilage.

19. A device for use in a surgical procedure, the device comprising a body member having a continuous bore for receiving a guide rod, and a hollow cutting blade for receiving the rod and having a rectangular cross section for cutting an opening having a rectangular cross section.

20. A surgical procedure comprising:

advancing a hollow tool over the rod until the tool extends to the damaged area; and

activating the tool to engage the damage area.

21. The procedure ofclaim 20 further comprising removing the tool from the rod;

advancing another tool over the rod until the other tool extends to the damage area, and

activating the other tool to engage the damage area.

22. The procedure ofclaim 21 wherein the first-mentioned tool is a drill bit that drills a hole in the damaged area during the first-mentioned step of activating.

23. The procedure ofclaim 22 wherein the other tool is a chisel that cuts a hole in the damaged area during the second-mentioned step of activating.

24. The procedure ofclaim 23 wherein the second-mentioned step of activating comprises exerting manual forces on the other tool.